Individual
THOMAS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1012 MAIN ST, ALAMOSA, CO 81101-2445
(719) 480-3438
Mailing address
1012 MAIN ST, ALAMOSA, CO 81101-2445
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0012342
CO
Other
Enumeration date
08/20/2013
Last updated
08/20/2013
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